Posted Mon Dec 18 01:40:00 EAT 2017

Health spending still low despite years of devolution

By DOROTHY OTIENO

Kenya is a good way off from meeting the pledge it made more than 15 years ago to spend 15 per cent of its budget on health, a Nation Newsplex review of county and national governments budgets shows.

Health constituted eight per cent of the combined national and county budget allocations in the 2016/17 fiscal year, which is about half of the country’s longstanding commitment, amounting to Sh172.5 billion.

It was also the same share as the previous year and one percentage point higher than in the 2014/15 financial year.

A third of the money allocated to health in the recurrent budget and two-thirds of the funds earmarked for development was not spent.

The proportions are consistent with what the government allocated to health before it was devolved. The percentage of the budget allocated to health in the final fiscal year before the introduction of the devolved system of government was also eight per cent.

When it comes to the actual spending, the shortfall is worse partly due to the challenges county governments are facing in implementing their budgets.

The analysis, based on the Controller of Budget’s reports, finds that the total public expenditure on health was five per cent of the overall spending by the two levels of government in 2016/17 or about Sh110 billion, a drop from six and seven per cent in the two previous years respectively.

Six countries

In 2001, officials from African Union member countries met in Abuja, Nigeria and pledged to set a target of at least 15 per cent of their annual national budgets to improve health.

According to the AU Commission, six countries have met the benchmark. They are Burkina Faso, Niger, Rwanda, Botswana, Malawi and Zambia.

However, the World Health Organisation says only Rwanda and South Africa have done so.

Health, along with agriculture and water, are some of the key services that were devolved to from the national government.

Data from the World Bank indicates that the public sector makes up about two-thirds of health spending in Kenya while public health expenditure as a share of Gross Domestic Product is about 3.5 per cent.

One in four shillings allocated by devolved governments goes to health. But even though most counties earmarked a sizeable share of their budgets to health in the last three financial years, their efforts were undermined by the low national government allocations of just two per cent of its overall budget to the sector during the 2014/15 to 2016/17 financial years.

The nurses’ strike ended on November 2 after 151 days while the doctors’ lasted 100 days by the time it was called off in mid-March.

In the last two financial years, health made up three per cent of the total national government spending, a fall by almost half from the 2013/14 fiscal year, the first budget under the devolved system of government.

At the county level, the combined allocations to health by devolved units was 21 per cent in the financial year 2014/15, which improved two points to 24 per cent in the following two financial years.

But when it comes to county expenditures, the proportion spent on health last year was 17 per cent or one in every six shillings used by counties. This was an eight percentage drop from the previous year. In the 2014/15 year, counties spent 22 per cent on health.

But even as the share of budget apportioned to and spent on health by counties is significant, the sector has been dogged by strikes and lack of basic equipment in public hospitals. The consequences have been dire.

The nurses’ strike ended on November 2 after 151 days while the doctors’ lasted 100 days by the time it was called off in mid-March.

During the strikes, the number of women who died in childbirth in public hospitals doubled nationally in the first half of 2017 to 857, compared to 413 in the first half of 2016, revealed an earlier Newsplexanalysis of service data recorded daily in the Kenya Health Information System.

Kenya is not only struggling to pay its health workers but also dealing with shortages.

There are 108 doctors and nurses per 100,000 people, about half of the World Health Organisation recommended rate, according to the Economic Survey 2016.

Unspent funds

Moreover, health allocations and spending among counties are not uniform, varying widely from region to region.

In the last fiscal year, slightly over half (56 per cent) of the Sh95.1 billion allocated to health by the devolved governments was spent, with the recurrent budget 62 per cent while the development absorption rate was 37 per cent.